# AFFILIATES OF FAMILY PRACTICE OF CEDAR RAPIDS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Affiliates of Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699880138
- **Authorized official:** MR. KENNETH ALBERT CEARLOCK MD (PARTNER OWNER)
- **Authorized official phone:** (319) 364-7730

## Contact information

- **Practice address:** 1030 5TH AVENUE SE, SUITE 1700, CEDAR RAPIDS, IA 52403
- **Practice address phone:** (319) 364-7730
- **Practice address fax:** (319) 364-0240
- **Mailing address:** 1030 5TH AVENUE SE, SUITE 1700, CEDAR RAPIDS, IA 52403
- **Mailing address phone:** (319) 364-7730
- **Mailing address fax:** (319) 364-0240

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 22198 | IA | Yes |
| 207Q00000X | Family Medicine Physician | 34383 | IA | — |

## Other

- **Enumeration date:** 08/21/2006
- **Last updated:** 08/22/2020